In the context of an increase in the number of methods aimed at correcting age-related changes and lip contouring, an important step is the choice of the optimal drug for work and the technique of the procedure, which in synergy will lead to an excellent result and satisfy the most demanding client.
In the article estet-portal.com you can get acquainted in detail with the algorithms of work and practical cases of professionals in aesthetic medicine: dermatovenereologist, cosmetologist, director of the Asclepius, Estimed clinics; (Uzhgorod), co-owner of the Dermarevolta clinic (Bratislava, Slovakia) Inga Voloshina-Andrashko and otolaryngologist, plastic surgeon, specialist in injection cosmetology, trainer of the Hyalual company Alexander Karpinsky.
Clinical Case #1: Justification for the need to correct age-related changes
Dr. Inga Voloshina-Andrashko presented her own experience of correcting age-related changes in a patient who complained of a tired look and requested correction to achieve "natural beauty".
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At an objective examination, it was found: "tired"; aging morphotype, oval face, dolichocephalic type of skull structure; asymmetry with respect to the central optical axis of the face and age-related involutive changes, namely: depression of the middle third and temporal zone, nasolacrimal and buccal sulcus, labiomental fold, labiomental wrinkles, deformity of the lower third (“flys”), saddle nose deformity.
Status localis: isolated telangiectasias were noted in the area of the cheeks and wings of the nose, the skin is dry, with reduced turgor, mimic wrinkles are moderately pronounced.
Clinical case #1: Step by step algorithm of work
1) With the help of a neodymium laser DEKA (Italy), coagulation of the vessels was carried out. It required two selective sclerosing procedures using a laser frequency of 1064 nm with an interval of 1 month.
2) To improve the condition of the external integument, three redermalization procedures were performed with XELA Rederm 1.1%, 2 ml (Hyalual 1.1%) from Hyalual, with an interval of three weeks.
3) To correct the periorbital zone — "crow's feet" — botulinum therapy was performed with Botox (Allergan), 20 IU. Injection correction was carried out in two stages: correction with fillers based on hyaluronic acid and lip contouring.
Clinical case #1: Correction with hyaluronic acid fillers
11 months after the initiation of therapy, the patient's face was corrected with Alexa hyaluronic fillers from Hyalual:
1) Alexa Volume Filler 20 mg/ml was injected retrograde supraperiosteally, 3–4 access points in bolus technique, in a volume of 0.5 ml on each side until visual tissue elevation was achieved.
2) The nasolacrimal trough was corrected with Alexa Smooth filler 15 mg/ml. Injected 0.5 ml per side using cannula technique (TSK 22 G cannula, 50 mm) under the orbicular muscle of the eye.
3) Alexa Volume was used in the temporal region. Cannula technique, insertion depth – between the superficial and deep layers of the temporal fascia. Entry point – lower 1/3 Linea Temporalis of the frontal bone.
4) The patient had a saddle nose deformity associated with childhood trauma. After a negative Cottle test, a decision was made to perform external nose contouring with Alexa Volume filler 20 mg/ml in a volume of 0.7 ml using a 22 G (50 mm) cannula.
Cottle's Sample — internal nasal valve collapse test.
Due to the absence of lidocaine in the preparation and the use of a cannula, it is possible to obtain a higher guarantee of safety and control of hypothetical ischemia or thrombosis of the angular artery, artery of the back of the nose and other small vessels of this complex anatomical zone.
Cannula or needle: features of the introduction of Hyalual preparations by different methods
5) Alexa Medium 17.5 mg/ml was used for lip correction with a volume of 0.8 ml for the purpose of "restoration of the lips" in a fan technique using 4 vertical and 4 horizontal fans to completely cover the area. Before the procedure, a topical anesthetic Anesthetic Pro Formula from Hyalual was applied.
6) The chin was corrected with a supraperiosteal bolus perpendicular to the skin of 0.5 ml Alexa Volume 20 mg/ml with a needle to improve the projection of the chin along the Ricketts line.
7) To correct "puppet wrinkles" 25 G cannula (50 mm) injected Alexa Volume 20 mg/ml in a volume of 0.5 ml per side. Hotspot — along the edge of the lower jaw, the preparation was left at the subdermal level in the projection of the corner of the mouth.
In such cases, an additional supraperiosteal bolus injection along the edge of the mandible is possible. The total volume of the group of companies — 6 ml, the scheme of administration is shown in photo 1. The result of therapy is shown in photo 2.
Clinical case #2: Lip contouring
Plastic surgeon, specialist in injection cosmetology and certified trainer Alexander Karpinsky presented the lip contouring algorithm:
1. Taking an anamnesis, examining the lips and nasolabial triangle, examining the patient's oral cavity and issuing voluntary informed consent, photographing the patient in several projections (full face, profile, semi-profile).
Don't forget to take pictures of the patient before and after the procedure, as well as 14 days later at the follow-up visit.
2. Make-up removal and cleansing of the nasolabial triangle area with 0.05% solution of Chlorhexidine bigluconate or 0.02% Decasan solution for external use.
3. Anesthetic Pro Formula local anesthetic for 15 minutes. Before the introduction of the drug based on hyaluronic acid, it is necessary to remove the anesthetic and re-treat the skin with an antiseptic agent.
4. Correction with Alexa Volume 20 mg/ml. The amount of the drug required for the procedure is determined individually, in general, up to 2 ml can be injected into the lip area in one session.
Depending on the physiology of the patient and his wishes, you can choose a linear retrograde, fan, bolus or microbolus correction technique.
Modeling of the injected drug should be performed with light massage movements, after completion of the correction, it is necessary to check for indurations and provide recommendations.
The results of lip contouring in different patients using the Alexa Volume 20 mg/ml filler are shown in the photo (before and after).
Thank you for staying with estet-portal.com. Read other interesting articles in the "Cosmetology" section. You may be interested in Comprehensive solutions to restore youth: Institute Hyalual
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